UQ-OCHSNER SEED FUND FOR COLLABORATIVE RESEARCH
2016 APPLICATION FORM
Due date for submission of Application to UQR&I: 25 November 2015
RM ID (UQ R&I use only):
SECTION A: SUMMARY APPLICATION DETAILS
A1. ORGANISATIONAL UNIT TO ADMINISTER THE GRANT (i.e. UQ School/Centre/Institute)
A2. PROJECT TITLE
Max. 20 words plain English
A3. SUMMARY DETAILS – OCS AFFILIATED CHIEF INVESTIGATORS
Full applicant details are provided in Part B of this application. There must be at least two CIs named – one
Ochsner Clinical School affiliated Academic Title Holder (A3) and at least one other eligible CI from another
academic unit within UQ (A4). The Lead CI must be placed first. Please list all OCS affiliated CIs below:
Family name
Initials
School/Centre
UQ Faculty/Institute
1
2
Please add or remove rows as necessary.
A4. SUMMARY DETAILS – OTHER CHIEF INVESTIGATORS
Full applicant details are provided in Part B of this application. Other CIs may be eligible UQ ATHs or other
eligible UQ staff. Refer to the scheme Guidelines for further information. Please list all Other CIs below:
Family name
Initials
UQ School/Centre
UQ Faculty/Institute
3
4
Please add or remove rows as necessary.
A5. REQUESTED SUPPORT
TOTAL funds requested in this application
$
This amount should match the Grand Total at C1.
A6. PROJECT SUMMARY
Provide a plain language summary of the aims, significance and expected outcomes (approx. 100 words).
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UQ-OCHSNER SEED FUND FOR COLLABORATIVE RESEARCH
2016 APPLICATION FORM
A7. RESEARCH CLASSIFICATIONS
 List from highest % to lowest %, and in multiples of 10.
 FOR and SEO Codes are available from: http://www.uq.edu.au/research/researchmanagement/research-classifications
 Use 6 digit codes only. Do not use codes ending in either ‘00’ or ‘0000’, as these are category
headings.
Field of Research (FOR)
– to total 100%
%
Socio-Economic Objective (SEO)
– to total 100%
%
A8. TYPE OF RESEACH
 Information on the types of research is available from: http://www.uq.edu.au/research/researchmanagement/type-of-activity-toa
 Ensure your percentages total to 100%.
Pure
%
Strategic
%
Applied
%
Experimental
%
A9. ETHICAL/BIOSAFETY CLEARANCES
(a) If this application is successful, will you require ethical and/or biosafety clearance?
Yes
No
(b)If yes, what category:
Human
http://www.uq.edu.au/research/integrity-compliance/human-ethics
Animal
http://www.uq.edu.au/research/integrity-compliance/animal-welfare
Biosafety
http://www.uq.edu.au/ohs/index.html?page=29969
Export Controls
http://www.uq.edu.au/research/integrity-compliance/strengthened-export-controls
Other
Please specify:
(c)If UQ Ethical/Biosafety Clearances already exist, insert UQ Clearance No:
A10. ADDITIONAL DETAILS OF OTHER SIMILAR APPLICATIONS
(a) Have you submitted a similar application to any other scheme?
Yes
No
(b) If yes, please provide details:
A11.
PRIORITY AREAS
(a) Does your application target a priority area, as per the guidelines?
Yes
No
(b) If yes, what area:
Neuroscience, brain and mental health
Cancer
Gastrointestinal
Cardiovascular
Health services
Reproductive, maternal child health
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UQ-OCHSNER SEED FUND FOR COLLABORATIVE RESEARCH
2016 APPLICATION FORM
SECTION B: PERSONNEL AND RELATED DETAILS
Please complete Section B for each named investigator on the application, duplicating the template content
below for additional investigators (if applicable).
B1. PERSON NUMBER
B2. APPLICANT DETAILS
Employee No. (if known)
Family name
Role
First name
CI
Second name
Title
School/Centre
Faculty/Institute
E-mail
OCS affiliated UQ
ATH
Appointment type
UQ Appointment Level
(eg Level A B, C, D, E).
Year of Appointment
B3.
UQ ATH
Year of Expiry
QUALIFICATIONS
B3.1 PhD qualification awarded
Discipline/Field
Organisation
Country
Month and Year awarded
B3.2
Telephone
UQ T&R; RO; TF; CA;
Eligible MRI-UQ
(or) Date Thesis Submitted/
Proposed Submission Date
Other qualifications (including highest Qualification if not PhD)
Degree/Award
Year
Discipline/Field
Organisation and country
B4. ACADEMIC, RESEARCH AND PROFESSIONAL EXPERIENCE
Current and previous appointment(s)/position(s) - covering a maximum of the past 10 years
Position held
Organisation
School/Institute/Centre/
Department
Year
Appointed
Current
(Yes/no)
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UQ-OCHSNER SEED FUND FOR COLLABORATIVE RESEARCH
2016 APPLICATION FORM
B5. RESEARCH RECORD RELATIVE TO OPPORTUNITIES
Using the headings below describe your contributions to research, research training and clinical outcomes.
B5.1 All refereed publications in the past 5 years (2010 onwards)
 Use asterisks (*) to identify publications relevant to this application.
 List publications under the following headings: Books, Book Chapters, Journal Articles.
 In-press publications are to include the acceptance date.
B5.2 Other relevant achievements
 Write a maximum of half an A4 page.
 For applicants previously named as a CI on a UQ-Ochsner Seed Fund for Collaborative Research
grant, describe and identify the outputs and outcomes of the earlier grant as part of your track
record/achievements statement.
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UQ-OCHSNER SEED FUND FOR COLLABORATIVE RESEARCH
2016 APPLICATION FORM
SECTION C: BUDGET
C1. BUDGET DETAILS
Please provide a detailed budget in the table below.
Detailed Budget (List all items individually)
Personnel
Total ($)
Sub-total
Equipment
Sub-total
Maintenance
Sub-total
Travel
Sub-total
Other
Sub-total
GRAND TOTAL
The maximum amount of funding per eligible application is $50,000.
C2. JUSTIFICATION OF FUNDING REQUESTED
In no more than half an A4 page, fully justify in terms of need and cost, each budget item requested.
Structure your budget justification under the same headings used in the table above.
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UQ-OCHSNER SEED FUND FOR COLLABORATIVE RESEARCH
2016 APPLICATION FORM
SECTION D: RESEARCH SUPPORT
D1. RESEARCH SUPPORT OF ALL PARTICIPANTS
Provide details for all participants listed in Section A.
 List this proposal first.
 Provide the names of all investigators on any grant held together with the project title, source of
support, scheme.
 Asterisk (*) refers to any items that are in the same area of research as this application.
 Support types (Sup type) are ‘C’ for current support, ‘R’ for requested support, ‘P’ for past support.
 The Project ID applies only to ARC or NHMRC grants.
 Note, details should be provided for all sources of funding for the years listed below.
Description
(All named investigators
on any grant held by a
participant, project title,
source of support,
scheme)
(*)
Sup
type
Grant ID
(If NHMRC or
ARC)
2014
2015
2016
2017
2018
($’000) ($’000) ($’000) ($’000) ($’000)
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UQ-OCHSNER SEED FUND FOR COLLABORATIVE RESEARCH
2016 APPLICATION FORM
SECTION E: PROJECT DESCRIPTION
Provide the following information in no more than four (4) A4 pages and in the required format of 11 point
font. Please refer to UQ-Ochsner Seed Fund for Collaborative Research Guidelines.
E1. AIMS
 Describe the aims of the project.
E2. APPROACH
 Outline the conceptual framework, design and methods and demonstrate that these are adequately
developed, well integrated and appropriate to the aims of the project.
E3. INNOVATION, CLINICAL RELEVANCE AND EXPECTED BENEFITS
 Describe how the anticipated outcomes will advance the knowledge base of the discipline and why
the project aims and concepts are novel and innovative. Detail what new methodologies or
technologies will be developed.
 Describe the clinical relevance of the anticipated outcomes
 What are the expected benefits of the project?
E4. COLLABORATION
 Summarise the role, responsibilities and contributions of each Chief Investigator and other research
collaborators.
 Explain how the project develops and enhances collaborations between researchers at UQ-OCS and
other UQ academic staff.
 Specify where the research will be conducted.
 Describe the collaborative arrangements, including the extent to which the proposed project involves
OCS and/or other UQ MBBS/MD students.
E5. PUBLICATIONS AND FUTURE FUNDING OPPORTUNITIES
 Describe your plans for scholarly publication.
 Outline your plans for disseminating results to the broader public and/or clinical audiences.
 How will this funding make your external grant applications more competitive? From which funding
agencies or schemes would subsequent external funding be sought?
E6. REFERENCES
 Include a list of all references. This may be in addition to the limit of four (4) A4 pages and may be in
10 point font.
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UQ-OCHSNER SEED FUND FOR COLLABORATIVE RESEARCH
2016 APPLICATION FORM
SECTION F: APPLICATION CERTIFICATIONS
All Chief Investigators listed in Section A must sign this Certification.
Certification Ochsner-affiliated ATH Chief Investigator(s)
I certify that:
i) To the best of my knowledge, all the details on this application form are true and complete.
ii) I have complied with the UQ-Ochsner Seed Fund for Collaborative Research Guidelines and if I am successful
I will accept the Conditions of Award relating to this scheme.
iii) I will comply with all necessary UQ policies and procedures in discharging my responsibilities under this
grant.
iv) I understand and agree that all ethical clearances must be met before the proposed research can
commence.
v) In submitting this application, I consent to its referral to internal (UQ) assessors for consideration.
Certification by Head of School/Centre/Institute Director:
I certify that:
i) If funded under this grant application and carried out within my organisational unit, the project can be
accommodated as appropriate within the general facilities of the organisational unit and that sufficient
working and office space is available for any proposed additional staff.
ii) I am prepared to have the project, if funded under this grant application, carried out under the
circumstances set out by the Applicant/s.
Person
Surname, title and initials
Signature of
Signature of Head of
(printed)
Chief Investigator
School/Centre/Institute
1
Certification by UQ ATH CIs and Other UQ CI Investigator(s)
I certify that:
vi) To the best of my knowledge, all the details on this application form are true and complete.
vii) I have complied with the UQ-Ochsner Seed Fund for Collaborative Research Guidelines and if I am successful
I will accept the Conditions of Award relating to this scheme.
viii) I will comply with all necessary UQ policies and procedures in discharging my responsibilities under this
grant.
ix) I understand and agree that all ethical clearances must be met before the proposed research can commence.
x) In submitting this application, I consent to its referral to internal (UQ) assessors for consideration.
Certification by Head of School/Centre/Institute Director:
I certify that:
iii) The project, if funded under this grant application, can be accommodated as appropriate within the general
facilities in my organisational unit and that sufficient working and office space is available for any proposed
additional staff.
iv) I am prepared to have the project, if funded under this grant application, carried out in my organisational
unit under the circumstances set out by the Applicant/s.
v) For salaried UQ CIs, I have noted the amount of time that the Applicant/s will be devoting to the project and
agree that it is appropriate to existing workloads.
Person
Surname, title and initials
Signature of
Signature of Head of
(printed)
Chief Investigator
School/Centre/Institute
2
3
4
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